Celebrating Alzheimer’s Awareness Day on Monday is a bit like our confrontation of global warming or the global population explosion – we understand the causes, but as a society, we have no idea how to respond.
For baby boomers, this is just the latest great social upheaval we are to live through: civil rights, the sexual revolution, Reaganomics, the Internet and now Alzheimer’s, the least silent killer we all live with but never discuss. Instead we choose to suffer through in silence as our prayers remain unanswered. For, according to the Alzheimer’s Association, there is no cure or meaningful slowing of the disease process.
We all have heard the statistics. Currently there are 5.2 million Americans with some form of dementia, and that number will increase by 38 percent in the next 10 years, reaching over 7 million. Put another way, 40 percent of the people reading this essay will be directly afflicted by the disease if they reach their mid 70s. The dreaded monster of dementia is currently attacking our parents but, as we all know, it awaits each of us.
We understand the disease process. As we age, protein deposits and neurofibrillary tangles build up in the brain, gradually shutting down brain function, most notably in areas controlling short-term memory and cognition. Compounding this slow death is the inevitable consequence of our physical decline as our vision, hearing and mobility are challenged.
We are left increasingly isolated and living in the past, measuring time not in minutes, but in memories. So the challenge for our generation is how to embrace our long-term memories to enhance comfort but, perhaps more challenging, what do we do if one’s long-term memories are frightening and traumatic? This is the great conundrum.
As a society facing this short-term/long-term memory balance, we fall squarely on the side of trying to preserve short-term memory as the preferred strategic approach. Memory care facilities are frequently marketing their ability to preserve short-term memory through exercise, diet and computer games. If you see your physician, he will prescribe Aricept to slow the disease process, and when you turn on the television, you will see commercials of jellyfish supplements and the benefits of mental exercise games or learning a second language.
This desire to try to keep a loved one in the present is understandable because we are terrified of losing the ones we love as they slip away into the past. But again, as the Alzheimer’s Association will tell you, these approaches are ultimately fool’s gold. I believe the more efficacious approach is to give ourselves over to comforting long-term memories such as religion, music and joyful reminiscing.
However, if the past is terrifying or frustrating, the journey can be perilous. People with no history of mental illness can become verbally abusive, violent and paranoid. A leader and pioneer in dealing with this challenge is Naomi Feil. She calls her approach the Validation Method.
Fundamental to Feil’s approach is that all behavior, no matter how irrational, has a cause in the past. If a woman tells me that there is a man in her room, she is not hallucinating, but reliving either a traumatic memory or expressing an unresolved life adjustment to, say, sexuality or intimacy. Modern psychology since Sigmund Freud would tell us that through psychoanalysis – discussing past suppressed memories – we can properly put the event in perspective and help to adjust our behaviors.
The problem, however, is that dementia patients don’t possess the requisite cognitive ability to process an analysis of the past and answer a “why” question. They are afraid and don’t want to relive the past, yet because they are losing control as they age, they can no longer suppress these long-term, unresolved memories.
Feil accepts this truth, but argues persuasively that through empathy and nonjudgmental dialogue, these stressful emotions can be relieved and lessened. To achieve this, she recommends listening and attempting to elicit conversation by asking questions about the who, what and when, of a disturbing memory, but not the why.
So, if an 80-year-old woman tells you that her father is picking her up for dinner, don’t remind her that her father died in a car accident 50 years earlier, forcing her to relive the tragedy. And don’t lie to her and tell her that he has just called and said he couldn’t make it tonight. Rather, Feil suggests you say, “tell me about your father,” and then let her talk.
The great insight here is that through a nonthreatening dialogue with an empathetic and nonjudgmental listener, painful emotions can be relieved and lessened, without being traumatic and threatening. Feil offers many techniques to achieve this. These include repeating phrases as questions, or asking an ambivalent question like, “was there ever a time that there wasn’t a man under your bed?” Keep in mind that the only real alternative to this model of care is either physical or pharmaceutical restraints.
So as we ponder these challenges on Alzheimer’s Awareness Day, we must appreciate how daunting a task awaits this generation and how far we have to go before we have a meaningful model of care that offers comfort and healing to our loved ones and ourselves. But if baby boomers want to take a longer view, they should look at themselves and their own unresolved emotional issues while they still possess the cognitive ability, so that they can avoid a stressful and painful old age.
Stephen S. Bowman is president of Peregrine Senior Living in Syracuse.